A mere fifteen minutes.

Firstword I glide through some days of my family practice with an effortless grace. I am on time for my appointments. I address patients’ concerns and mine in unrushed, friendly visits. There is rhythm and joy in what I do. Then, there are days when I seem to be mired in wet concrete. I am neither fast nor efficient, and many patient encounters end with the feeling that nothing was accomplished. On those days, I leave feeling inept. George Whitacker was one of my last patients on a wet-cement day, and I was an hour behind schedule. Pulling his chart from the door rack, my frustration edged higher when I realized that it had been more than 1 year since I had seen George. He needed a complete physical examination but had been scheduled for only a 15-minute visit. I was distracted and wrapped in self-pity as I entered the room to greet George and his wife, Helga. The Whitackers had been my patients for 15 years. They had been together much longer. Both had been mostly healthy, seeing me once or twice a year. Even at 70 years old, George had a muscular physique sculpted by his years of labor in heavy manufacturing. The machinery noise had left him partially deaf. His only other problems were wellcontrolled hypertension and prostate cancer, which had been diagnosed at an early stage 3 years ago. We were both optimistic that he had been cured. Helga, who was 4 years George’s junior, had also been fortunate with her health. Having finally conquered her stubborn hot flashes, I treated her for mild hypertension and insomnia. They were saltof-the-earth folks who took care of themselves and each other. Feeling rushed, I eschewed my normal openended greeting and tried to be directive. “So, George, you’re here for a recheck of your blood pressure, and you’re overdue for a physical.” George peered at me from behind his thick, black-rimmed glasses and responded slowly, “Well, yes.” Helga, forthright as always, chimed in. “We are really worried about his memory. He is too forgetful, and the problem seems to be getting worse.” I looked at Helga and George. Real concern was etched on their faces. This visit would not be quick; no easy answers here. Trying purposefully to forget my frustrations, I scooted my stool against the wall, leaned back, and listened. The tale was all too familiar. For at least a year, George had been having a problem with his memory. At first they had written it off to age and stress. Of late, George and Helga could no longer deny the possibility of dementia. Having heard their concerns, I tried to negotiate a compassionate conclusion to the visit. George’s story and affect made it clear that he did not have the pseudodementia of depression. We agreed that I would order the tests to rule out the reversible causes of dementia and see them again in 10 days. Then we could review the test results together, and I could administer a Folstein Mini-Mental Status Examination. We shook hands, and I turned George and Helga over to my nurse. I felt guilty as I rushed off to see my next patient. I had spent the day feeling sorry for myself. George’s visit had provided me with a better perspective. The Whitackers returned late in the afternoon, exactly 10 days later. Although this day had not flowed gracefully, I was only 10 minutes behind when I plucked George’s chart from the door. I kicked myself for not being more careful in filling out his previous encounter form. Once again, he was only scheduled for a 15-minute visit. I sensed their fear as soon as I entered the room. I tried to break the ice by telling them that George’s tests were normal. I had not found any Submitted 23 January 2001. From the Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, the Greensboro Area Health Education Center, Greensboro, and the Moses Cone Health System Family Medicine Residency Program in Greensboro, NC. Address reprint requests to William A. Hensel, MD, Moses Cone Family Practice Center, 1125 N Church St, Greensboro, NC 27401-1007.